Section of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Allé 20, 2200 N, Copenhagen, Denmark,
Support Care Cancer. 2013 Nov;21(11):3223-32. doi: 10.1007/s00520-013-1884-6. Epub 2013 Jul 31.
The aim of this systematic review was to analyze the available literature and define clinical practice guidelines for the use of the following agents for the prevention and treatment of oral mucositis (OM): allopurinol, midline mucosa-sparing radiation blocks, payayor, pentoxifylline, timing of radiation therapy (RT) (morning versus late afternoon), pilocarpine, bethanechol, chewing gum, propantheline, and tetrachlorodecaoxide.
A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, no guideline possible.
A total of 32 papers across 10 interventions were examined. New suggestions were developed against the use of systemic pilocarpine administered orally for prevention of OM during RT in head and neck cancer patients and in patients receiving high-dose chemotherapy, with or without total body irradiation, prior to hematopoietic stem cell transplantation. A suggestion was also made against the use of systemic pentoxifylline administered orally for the prevention of OM in patients undergoing bone marrow transplantation. No guideline was possible for any other agent reviewed due to inadequate and/or conflicting evidence.
None of the agents reviewed was determined to be effective for the prevention or treatment of OM. Two agents, pilocarpine and pentoxifylline, were determined to be ineffective, in the populations listed above. Additional well-designed research is needed on other interventions.
本系统评价旨在分析现有文献，并为以下药物在预防和治疗口腔黏膜炎（OM）中的应用制定临床实践指南：别嘌醇、中线黏膜保护辐射块、帕莱洛尔、己酮可可碱、放射治疗（RT）时间（上午与下午晚些时候）、毛果芸香碱、氨甲酰胆碱、口香糖、丙哌维林和四氯代十氧杂环十二烷。
多学科支持治疗癌症/国际口腔肿瘤协会（MASCC/ISOO）黏膜病研究小组进行了系统评价。对每种干预措施在每种癌症治疗环境中的证据体进行了证据水平评估。基于证据水平，可能会做出以下三种指南决定之一：推荐、建议、无可能的指南。
共检查了 10 项干预措施的 32 篇论文。针对头颈部癌症患者和接受高剂量化疗、全身放疗、造血干细胞移植前的患者，提出了反对使用全身毛果芸香碱预防 RT 期间 OM 的新建议。还建议反对使用全身己酮可可碱预防骨髓移植患者的 OM。由于证据不足和/或相互矛盾，对于审查的任何其他药物，均不可能制定指南。
在预防或治疗 OM 方面，没有一种被审查的药物被确定为有效。在上述人群中，两种药物，毛果芸香碱和己酮可可碱，被确定为无效。需要对其他干预措施进行更多设计良好的研究。
